Provider Demographics
NPI:1669414520
Name:GLOTZER, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GLOTZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 37TH PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4806
Mailing Address - Country:US
Mailing Address - Phone:772-563-4741
Mailing Address - Fax:772-563-4646
Practice Address - Street 1:1040 37TH PL
Practice Address - Street 2:SUITE 201
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4806
Practice Address - Country:US
Practice Address - Phone:772-563-4741
Practice Address - Fax:772-563-4646
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223482208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1763937Medicaid
NY56624UMedicare ID - Type Unspecified
NY1763937Medicaid